Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 062: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility IP

$31,289.71

Service Code	MS-DRG 062
Min. Negotiated Rate	$18,576.00
Max. Negotiated Rate	$31,289.71
Rate for Payer: EPIC Health Plan Commercial	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$21,280.57
Rate for Payer: Humana Medicare	$21,280.57
Rate for Payer: IEHP Medicare Advantage	$21,280.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,111.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,813.52
Rate for Payer: Molina Healthcare of CA Medicare	$26,813.52
Rate for Payer: Multiplan WC	$31,289.71

INPATIENT MS-DRG 063: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility IP

$25,802.75

Service Code	MS-DRG 063
Min. Negotiated Rate	$16,946.42
Max. Negotiated Rate	$25,802.75
Rate for Payer: EPIC Health Plan Commercial	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$16,946.42
Rate for Payer: Humana Medicare	$16,946.42
Rate for Payer: IEHP Medicare Advantage	$16,946.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,996.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,352.49
Rate for Payer: Molina Healthcare of CA Medicare	$21,352.49
Rate for Payer: Multiplan WC	$25,802.75

INPATIENT MS-DRG 064: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility IP

$32,184.08

Service Code	MS-DRG 064
Min. Negotiated Rate	$18,576.00
Max. Negotiated Rate	$32,184.08
Rate for Payer: EPIC Health Plan Commercial	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$22,759.06
Rate for Payer: Humana Medicare	$22,759.06
Rate for Payer: IEHP Medicare Advantage	$22,759.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,855.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,676.42
Rate for Payer: Molina Healthcare of CA Medicare	$28,676.42
Rate for Payer: Multiplan WC	$32,184.08

INPATIENT MS-DRG 065: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility IP

$18,576.00

Service Code	MS-DRG 065
Min. Negotiated Rate	$11,649.51
Max. Negotiated Rate	$18,576.00
Rate for Payer: EPIC Health Plan Commercial	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$11,649.51
Rate for Payer: Humana Medicare	$11,649.51
Rate for Payer: IEHP Medicare Advantage	$11,649.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,746.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,678.38
Rate for Payer: Molina Healthcare of CA Medicare	$14,678.38
Rate for Payer: Multiplan WC	$16,588.19

INPATIENT MS-DRG 066: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility IP

$18,576.00

Service Code	MS-DRG 066
Min. Negotiated Rate	$7,945.94
Max. Negotiated Rate	$18,576.00
Rate for Payer: EPIC Health Plan Commercial	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$7,945.94
Rate for Payer: Humana Medicare	$7,945.94
Rate for Payer: IEHP Medicare Advantage	$7,945.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,376.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,011.88
Rate for Payer: Molina Healthcare of CA Medicare	$10,011.88
Rate for Payer: Multiplan WC	$11,399.89

INPATIENT MS-DRG 067: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility IP

$23,078.86

Service Code	MS-DRG 067
Min. Negotiated Rate	$16,159.33
Max. Negotiated Rate	$23,078.86
Rate for Payer: EPIC Health Plan Medicare	$16,159.33
Rate for Payer: Humana Medicare	$16,159.33
Rate for Payer: IEHP Medicare Advantage	$16,159.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,068.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,360.76
Rate for Payer: Molina Healthcare of CA Medicare	$20,360.76
Rate for Payer: Multiplan WC	$23,078.86

INPATIENT MS-DRG 068: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility IP

$14,748.86

Service Code	MS-DRG 068
Min. Negotiated Rate	$10,012.24
Max. Negotiated Rate	$14,748.86
Rate for Payer: EPIC Health Plan Medicare	$10,012.24
Rate for Payer: Humana Medicare	$10,012.24
Rate for Payer: IEHP Medicare Advantage	$10,012.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,814.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,615.42
Rate for Payer: Molina Healthcare of CA Medicare	$12,615.42
Rate for Payer: Multiplan WC	$14,748.86

INPATIENT MS-DRG 069: TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility IP

$18,576.00

Service Code	MS-DRG 069
Min. Negotiated Rate	$9,198.10
Max. Negotiated Rate	$18,576.00
Rate for Payer: EPIC Health Plan Commercial	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$9,198.10
Rate for Payer: Humana Medicare	$9,198.10
Rate for Payer: IEHP Medicare Advantage	$9,198.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,853.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,589.61
Rate for Payer: Molina Healthcare of CA Medicare	$11,589.61
Rate for Payer: Multiplan WC	$13,022.15

INPATIENT MS-DRG 070: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC

Facility IP

$28,139.86

Service Code	MS-DRG 070
Min. Negotiated Rate	$20,354.97
Max. Negotiated Rate	$28,139.86
Rate for Payer: EPIC Health Plan Medicare	$20,354.97
Rate for Payer: Humana Medicare	$20,354.97
Rate for Payer: IEHP Medicare Advantage	$20,354.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,018.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,647.26
Rate for Payer: Molina Healthcare of CA Medicare	$25,647.26
Rate for Payer: Multiplan WC	$28,139.86

INPATIENT MS-DRG 071: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC

Facility IP

$17,446.65

Service Code	MS-DRG 071
Min. Negotiated Rate	$12,160.73
Max. Negotiated Rate	$17,446.65
Rate for Payer: EPIC Health Plan Medicare	$12,160.73
Rate for Payer: Humana Medicare	$12,160.73
Rate for Payer: IEHP Medicare Advantage	$12,160.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,349.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,322.52
Rate for Payer: Molina Healthcare of CA Medicare	$15,322.52
Rate for Payer: Multiplan WC	$17,446.65

INPATIENT MS-DRG 072: NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility IP

$12,599.45

Service Code	MS-DRG 072
Min. Negotiated Rate	$9,021.31
Max. Negotiated Rate	$12,599.45
Rate for Payer: EPIC Health Plan Medicare	$9,021.31
Rate for Payer: Humana Medicare	$9,021.31
Rate for Payer: IEHP Medicare Advantage	$9,021.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,645.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,366.85
Rate for Payer: Molina Healthcare of CA Medicare	$11,366.85
Rate for Payer: Multiplan WC	$12,599.45

INPATIENT MS-DRG 073: CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility IP

$24,469.37

Service Code	MS-DRG 073
Min. Negotiated Rate	$17,241.44
Max. Negotiated Rate	$24,469.37
Rate for Payer: EPIC Health Plan Medicare	$17,241.44
Rate for Payer: Humana Medicare	$17,241.44
Rate for Payer: IEHP Medicare Advantage	$17,241.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,344.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,724.21
Rate for Payer: Molina Healthcare of CA Medicare	$21,724.21
Rate for Payer: Multiplan WC	$24,469.37

INPATIENT MS-DRG 074: CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility IP

$16,705.69

Service Code	MS-DRG 074
Min. Negotiated Rate	$11,759.84
Max. Negotiated Rate	$16,705.69
Rate for Payer: EPIC Health Plan Medicare	$11,759.84
Rate for Payer: Humana Medicare	$11,759.84
Rate for Payer: IEHP Medicare Advantage	$11,759.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,876.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,817.40
Rate for Payer: Molina Healthcare of CA Medicare	$14,817.40
Rate for Payer: Multiplan WC	$16,705.69

INPATIENT MS-DRG 075: VIRAL MENINGITIS WITH CC/MCC

Facility IP

$29,784.96

Service Code	MS-DRG 075
Min. Negotiated Rate	$21,754.65
Max. Negotiated Rate	$29,784.96
Rate for Payer: EPIC Health Plan Medicare	$21,754.65
Rate for Payer: Humana Medicare	$21,754.65
Rate for Payer: IEHP Medicare Advantage	$21,754.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,670.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,410.86
Rate for Payer: Molina Healthcare of CA Medicare	$27,410.86
Rate for Payer: Multiplan WC	$29,784.96

INPATIENT MS-DRG 076: VIRAL MENINGITIS WITHOUT CC/MCC

Facility IP

$16,113.26

Service Code	MS-DRG 076
Min. Negotiated Rate	$10,592.14
Max. Negotiated Rate	$16,113.26
Rate for Payer: EPIC Health Plan Medicare	$10,592.14
Rate for Payer: Humana Medicare	$10,592.14
Rate for Payer: IEHP Medicare Advantage	$10,592.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,498.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,346.10
Rate for Payer: Molina Healthcare of CA Medicare	$13,346.10
Rate for Payer: Multiplan WC	$16,113.26

INPATIENT MS-DRG 077: HYPERTENSIVE ENCEPHALOPATHY WITH MCC

Facility IP

$25,528.57

Service Code	MS-DRG 077
Min. Negotiated Rate	$17,217.79
Max. Negotiated Rate	$25,528.57
Rate for Payer: EPIC Health Plan Medicare	$17,217.79
Rate for Payer: Humana Medicare	$17,217.79
Rate for Payer: IEHP Medicare Advantage	$17,217.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,316.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,694.42
Rate for Payer: Molina Healthcare of CA Medicare	$21,694.42
Rate for Payer: Multiplan WC	$25,528.57

INPATIENT MS-DRG 078: HYPERTENSIVE ENCEPHALOPATHY WITH CC

Facility IP

$16,203.02

Service Code	MS-DRG 078
Min. Negotiated Rate	$11,655.14
Max. Negotiated Rate	$16,203.02
Rate for Payer: EPIC Health Plan Medicare	$11,655.14
Rate for Payer: Humana Medicare	$11,655.14
Rate for Payer: IEHP Medicare Advantage	$11,655.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,753.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,685.48
Rate for Payer: Molina Healthcare of CA Medicare	$14,685.48
Rate for Payer: Multiplan WC	$16,203.02

INPATIENT MS-DRG 079: HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC

Facility IP

$11,977.64

Service Code	MS-DRG 079
Min. Negotiated Rate	$8,546.13
Max. Negotiated Rate	$11,977.64
Rate for Payer: EPIC Health Plan Medicare	$8,546.13
Rate for Payer: Humana Medicare	$8,546.13
Rate for Payer: IEHP Medicare Advantage	$8,546.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,084.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,768.12
Rate for Payer: Molina Healthcare of CA Medicare	$10,768.12
Rate for Payer: Multiplan WC	$11,977.64

INPATIENT MS-DRG 080: NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility IP

$33,290.61

Service Code	MS-DRG 080
Min. Negotiated Rate	$25,075.34
Max. Negotiated Rate	$33,290.61
Rate for Payer: EPIC Health Plan Medicare	$25,075.34
Rate for Payer: Humana Medicare	$25,075.34
Rate for Payer: IEHP Medicare Advantage	$25,075.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,588.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,594.93
Rate for Payer: Molina Healthcare of CA Medicare	$31,594.93
Rate for Payer: Multiplan WC	$33,290.61

INPATIENT MS-DRG 081: NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility IP

$14,663.99

Service Code	MS-DRG 081
Min. Negotiated Rate	$10,445.76
Max. Negotiated Rate	$14,663.99
Rate for Payer: EPIC Health Plan Medicare	$10,445.76
Rate for Payer: Humana Medicare	$10,445.76
Rate for Payer: IEHP Medicare Advantage	$10,445.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,326.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,161.66
Rate for Payer: Molina Healthcare of CA Medicare	$13,161.66
Rate for Payer: Multiplan WC	$14,663.99

INPATIENT MS-DRG 082: TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility IP

$36,970.89

Service Code	MS-DRG 082
Min. Negotiated Rate	$25,859.05
Max. Negotiated Rate	$36,970.89
Rate for Payer: EPIC Health Plan Medicare	$25,859.05
Rate for Payer: Humana Medicare	$25,859.05
Rate for Payer: IEHP Medicare Advantage	$25,859.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,513.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,582.40
Rate for Payer: Molina Healthcare of CA Medicare	$32,582.40
Rate for Payer: Multiplan WC	$36,970.89

INPATIENT MS-DRG 083: TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility IP

$22,003.33

Service Code	MS-DRG 083
Min. Negotiated Rate	$15,478.05
Max. Negotiated Rate	$22,003.33
Rate for Payer: EPIC Health Plan Medicare	$15,478.05
Rate for Payer: Humana Medicare	$15,478.05
Rate for Payer: IEHP Medicare Advantage	$15,478.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,264.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,502.34
Rate for Payer: Molina Healthcare of CA Medicare	$19,502.34
Rate for Payer: Multiplan WC	$22,003.33

INPATIENT MS-DRG 084: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility IP

$14,957.76

Service Code	MS-DRG 084
Min. Negotiated Rate	$10,560.62
Max. Negotiated Rate	$14,957.76
Rate for Payer: EPIC Health Plan Medicare	$10,560.62
Rate for Payer: Humana Medicare	$10,560.62
Rate for Payer: IEHP Medicare Advantage	$10,560.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,461.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,306.38
Rate for Payer: Molina Healthcare of CA Medicare	$13,306.38
Rate for Payer: Multiplan WC	$14,957.76

INPATIENT MS-DRG 085: TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility IP

$38,119.85

Service Code	MS-DRG 085
Min. Negotiated Rate	$25,797.13
Max. Negotiated Rate	$38,119.85
Rate for Payer: EPIC Health Plan Medicare	$25,797.13
Rate for Payer: Humana Medicare	$25,797.13
Rate for Payer: IEHP Medicare Advantage	$25,797.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,440.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,504.38
Rate for Payer: Molina Healthcare of CA Medicare	$32,504.38
Rate for Payer: Multiplan WC	$38,119.85

INPATIENT MS-DRG 086: TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility IP

$21,211.79

Service Code	MS-DRG 086
Min. Negotiated Rate	$15,035.52
Max. Negotiated Rate	$21,211.79
Rate for Payer: EPIC Health Plan Medicare	$15,035.52
Rate for Payer: Humana Medicare	$15,035.52
Rate for Payer: IEHP Medicare Advantage	$15,035.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,741.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,944.76
Rate for Payer: Molina Healthcare of CA Medicare	$18,944.76
Rate for Payer: Multiplan WC	$21,211.79

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